HomeMy WebLinkAboutUtility Company ApprovalS,' , L" ST LUCIE COUNTY WATER & SEWER:DISTRICT (SLCU)
NEW CUSTOMER APPLICATION
V W.M.
mv. W"C'.
ATER OMM
Q-1`�./v . �: :. 7d
SEWER ✓ RES
NAME -i - �!v'
M
METER SZ. M/F
O
y SECURITY DEP
SERVICE ADDRESS
SERVICE FEE
Fort Pierce, FL 34945 ,
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3
SAME DAY FEE
SUBDIVISION .: LO T BLOCK
OVERTIME FEE
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METER INSTAL
BILLING ADDRESS
CFC/WATER
EMAILADDRESS DMPARRINQCDDRHORTON.COM
FPUA CFC
p�cJ GJ! / + .
PHONE MOVE: DATE
CFC/SEWER
GUAR. REV.
This application hereby requests and authorizes the Utilityto render water and/orsewage disposal
services to the premises described above in accordance with the Utilities presentor future rates, rules and
LATERAL
regulations, which:by reference are made. a part.. ofthis contract.:Appiicapt agrees to pay Utility: promptly for
such services In with the established rules and regulations.:.. .
$ TOTAL
.accordance
CUSTOMERS DEPOSITS ARE NON NE6QTIABLE OR TRANSFERABLE.
APPLICANT AGREES THAT. APPLICANT WILT, BEGAN PAYING BASE FACIITTY CHARGES FOR THE VfffXW SERVICE
"PLIEDAFOR ON TEE DAY THE WATER METER OR OTHER 1 JT'.I = SERVICE.: CONNECTION IS INSTALLED . AT
APPLICANNS PROPERTY, REGARDLESS OF WBEN APPLICANT STARTS UTUVWG THE METERANDIOR SERVICE... -
CUSTOMER SIGNATURE i1tl� 2i�Lytd
. SOCIAL SEC/FED ID . —
NAME A F SPOUSE
SPOUSE SOCIAL -
OFFICE USE ONLY
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DATE -RECEIVED �' '"t Z�
CASH 9wfieff# RECEIVED BY u .